Majority of GPs reject NICE proposals to extend statins to millions more

Exclusive The majority of GPs do not support NICE proposals which will see millions more patients become eligible for statins treatment, and most would not want themselves or their own families to be treated according to the new draft guidance, a Pulse survey has found.

The multi-topic survey of 511 GPs found that almost six out of ten (57%) oppose the plan to lower the current 10-year risk threshold for primary prevention from 20% to 10%, while only 25% support it.

And while only 15% said they would not adhere to the new threshold if it is confirmed in the final version of the NICE guidance, many are clearly uncomfortable with the recommendation, with 55% saying they would not personally take a statin or recommend a family member do so based on a 10% 10-year risk score.

GP leaders have also warned the new threshold will have a major effect on practices’ workload, and exacerbate existing access problems.

NICE’s proposal – unveiled in draft guidance last month – could see more than twice as many people over 40 start taking a statin to lower their risk of suffering a first heart attack or stroke, with the number eligible for treatment estimated to rise from around five to 12 million.

The institute has said its guidance is based on the ‘best available research evidence’ and that drug therapy plays a key role in helping patients with high cholesterol levels reduce their risk of cardiovascular disease.

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But Pulse’s survey found many GPs are sceptical of these claims, and even those who are supportive of the move harbour concerns over workload. Some 79% of respondents predicted that the shift to a 10% threshold would result in a ‘major’ or ‘signifcant’ increase in GP workload.

One GP respondent commented: ‘[This is] completely unrealistic to achieve and at a cost of huge morbidity in terms of statin side effects.’

‘GPs don’t have the capacity to have the time needed for conversations with patients if the goal posts are shifted further in this direction.’

Dr Andrew Green, chair of the GPC’s clinical and prescribing subcommittee and a GP in Hedon, East Yorkshire, told Pulse the NICE proposals would pile pressure on practices.

Dr Green said: ‘If you were to try to do on each patient everything that’s recommended in the document, you would certainly need a large number of appointments just to deal with that one patient.’

‘We need to look at the lost opportunity costs, because general practice does not have spare appointments. If we’re going to spend appointments doing this, it inevitably means other people who may well be at higher risk than these people will find it harder to get to see their GP.’

He added: ‘We already saw the work from the RCGP published last week suggesting people are finding it difficult to get to see their GP and this can only make the problem worse.’

Dr Chris Arden, cardiac lead at West Hampshire CCG and a GPSI in cardiology in Southampton, said he also has reservations about the move to lower the 10-year risk threshold.

‘There is a lot of sentiment that the delivery of this is going to be very challenging and that needs to be taken into account,’ he said.

‘I’m sure [NICE] have shown it will be cost-effective – statins are so cheap and cheerful. The cost aspect probably does stack up. But I think the implementation and the delivery hasn’t really been thought through.’

Professor Mark Baker, director of the Centre for Clinical Practice at NICE, said: ‘Drug therapy plays a key role in the management of people with high cholesterol levels to help reduce their risk of cardiovascular disease and this is properly reflected in the draft guideline which provides clear advice, based on the best available research evidence.’

‘It is the responsibility of GPs to explain the ways in which people can reduce their risk of cardiovascular disease, presenting all the options promoted by this draft guidance, including lifestyle changes, BP control, avoidance of diabetes and lipid lowering and allow patients to make their own decisions. It should be noted that this is draft guidance and we are currently consulting with stakeholders to get their views.’

About the survey: Pulse launched this survey of readers on 24 February 2013, collating responses using the SurveyMonkey tool. The 29 questions asked covered a wide range of GP topics, to avoid selection bias on any one issue. The survey was advertised to readers via our website and email newsletters, with a prize draw for a Samsung HD TV as an incentive to complete the survey.

As part of the survey, respondents were asked to specify their job title. A small number of non-GPs were screened out to analyse the results for this question. These questions were answered by 511 GPs.

its only a guidance and not written on stone but I believe all therapies should be tailor made for better concordance and medicines optimization -hence those patients who will benefit should get it-even with the 10% risk

But where is the resource? Even at £1.17/month for 1 million Pts, we are talking well over 12mil/year, just on the cost of the drugs. And that's even before time for clinicians and complications.........

All based on RCTs sponsored by...you've guessed it...Big Pharma. So the results may not be that reliable and certainly not worth pursuing by primary care. If NICE and public health support this, then sell it over the counter but it should not be something we deliver in primary care unless the time and staff are properly resourced.

NICE was a Nice idea, but it turns out NICE is so not so nice after all and it would be very nice if NICE were to listen to GP concerns before arguing more NICE guidelines which won't work in the nice but real world.

One thing one has to realise : many of these patients are likely NOT taking any regular medication prior to being told their CVD risk is >10% . Otherwise , it is all about effort to 'change' to a everyday medication behaviour and be compliant. Do all these academics know how hard it is? While I do not have any problem with the science , it is about treating our patients in a holistic way, easy said than done. The temptation at the end is just treating them like piles of figures and numbers ( because we have no time). Sad but true.......